oncology/gi/meds Flashcards

1
Q

damage to the DNA of your cell

A

cancer

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2
Q

top cancers for women

A

breast
colon
lung
liver

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3
Q

top cancer for men

A

prostate
lung
liver
colon

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4
Q

controls growth cells

A

proto-oncogene

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5
Q
  • mutated proto-oncogene
  • uncontrolled cell growth
A

oncogene

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6
Q

slows down cellular division, cause cell death

A

tumor suppressor gene

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7
Q

uncontrolled cell growth

A

mutated tumor suppressor gene

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8
Q

resemble normal cell
less aggressive
typically benign

A

well differentiated

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9
Q

function more like normal cell
grow slower rate

A

well differentiated

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10
Q

do not resemble normal cell
aggressive
typically malignant

A

poorly differentiated

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11
Q

immature cells
lack structure/function

A

poorly differentiated

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12
Q

tumor cells grow only locally and cannot spread by unvasioin or metastasis

A

benign (non cancer)

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13
Q

cells invade neighboring tissue, enter blood vessels, and metastasize to different sites

A

malignant (cancer)

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14
Q

well differentiated cells

A

benign

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15
Q

usually localized effects

A

benign

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16
Q

(destruction) usually none unless flow impaired

A

benign

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17
Q

morbillity- minimal unless location interferes with vital function

A

benign

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18
Q

poorly differentiated cells

A

malignant

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19
Q

generalized: anemia, weakness, wt loss

A

malignant

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20
Q

often extensive; excretes toxins, uses up blood supply

A

malignant

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21
Q

high- unless growth and spread can be controlled/halted

A

malignant

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22
Q

“fingers” of cancer cells invade surrounding tissuw

A

locally invasive

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23
Q

malignant cells travel through blood or lymph system & invade other tissues or organs to form secondary tumor

A

metastasis

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24
Q

what are the common sites of metastases

A

lung
brain
liver
bone

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25
what are the risk factors for cancer?
tobacco and smoking diet and obesity sedentary lifestyle occupational exposure family history viruses peritnatal factors/growth alcohol socioeconomic status pollution UV radiation drugs and medical procedures salt, food additives and contaminants
26
what is the hallmark of hereditary cancer syndrome?
-cancer in 2 or more relatives -cancer in family member <50 years old -same type of cancer in multiple family members -rare type of cancer in 1 or more family members - family members with more than 1 type of cancer
27
causes inflammation that can cause mutation suppress the immune system
viruses
28
what are some virus examples that can turn into cancers?
HPV Hepatitis B/Hepatitis C Epstein-Barr Human Herpes Virus 8 HIV Helicobacter pylori
29
HPV
cervical cancer
30
Hepatitis B/Hepatitis C
liver cancer
31
Epstein Barr
Lymphoma
32
HIV
Lymphoma Kaposi's sarcoma
33
Helicobacter pylori
stomach ulcers lymphoma in the stomach lining
34
-health promotions and illness prevention -reduction of cancer mortality via reduction in the incidence of cancer -lifestyle change, diet, adequate nutrients, avoiding alcohol, stress reduction
primary prevention
35
-screening (self breast and testicular exams) -halt the progress of cancer through early screening and diagnosis -targets to a specific cancer (pap smear, mammogram, colonoscopy, etc..)
secondary prevention
36
- disease treatment and rehabilitation -health restoration -prevent further deterioration (chemotherapy, radiation, surgery, -disease treatment
tertiary prevention
37
look for cancer before symptoms appear - goal: find cancer in the early stages
screening
38
what are the types of screening?
-physical exam -lab tests -imaging procedures -genetic testing
39
what age are the colorectal screening guidelines
beginning at 45 for both males and females
40
when should the fecal occult blood (FOBT)type be taken?
yearly
41
when should the flexible sigmoidoscopy be taken?
every 5 years
42
when should colonoscopy be given?
every 10 years
43
is colon cancer slow growing or fast growing?
slow growing
44
when should you start doing SBEs?
age 20+
45
at what age should breast exams be done by the HCP every 3 years?
age 40-44
46
at what age should HCP do breast exam and mammo yearly?
age 45-54
47
at what age should you go to see the HCP for a breast exam every 2 years?
age 55
48
when should pts go to the HCP if they are at high risk for cancer?
pts should go to the HCP to do MRI and mammogram yearly
49
what is the cervical screening?
pap smear women should go to HCP within 3 years of initiating intercourse
50
what are the 7 warning signs of cancer?
-change in bowel or bladder habit -a sore that does not heal -unusual bleeding or discharge -thickening or lump in breast or else where -indigestion or difficult swallowing -obvious change in a wart or mole -nagging cough or hoarseness
51
pathologist compares the appearance of cancer cells to the normal surrounding cells
grading
52
classifying a malignancy by the extent of spread within the body
staging
53
who does the grading/differentiate?
pathologist
54
who does the staging?
oncologist
55
GX
can not be assessed
56
G1
(low grade):well differentiated, slow growing
57
G2
(moderate grade): moderately differentiated, growing slightly faster
58
G3
(high grade): poorly differentiated, growing faster
59
G4
(high grade):undifferentiated, not distinct at all, very aggressive
60
Stage 1
small cancer found only in organ where it originated
61
stage 2
larger cancer that may/may not have spread to the lymph nodes
62
stage 3
larger cancer also in the lymph nodes
63
stage4
cancer has spread from original site into other organs
64
what is the tnm system?
it is the staging process
65
what does t stand for?
t-size of primary tumor
66
what does the n stand for?
n- number of lymph nodes involved
67
what does the m stand for?
m- extent of metastasis
68
Tx
tumor size can't be measured
69
T0
no primary tumor, or can't be found
70
Tis
tumor is "in situ"
71
T1
small or early stage
72
T2
confined to original area
73
T3
has spread to surrounding tissues
74
T4
large, advanced stage cancer
75
what are the worse tumor sizes?
TX, T0, & T4
76
NX
nearby nodes can't be tested/evaluated
77
N0
lymph nodes are cancer free
78
N1
cancer cells have reached one node
79
N2
cancer spread to more than one node
80
N3
cancer in lymph nodes extensive/widespread
81
M1
Cancer has spread to one or more distant part of the body
82
still in the original tissue layer
in situ
83
still in the original organ
localized
84
spread to nearby lymph nodes or organs
regional
85
spread to distant body parts
distant
86
what is the difference between in situ and localized?
in situ is only in one layer of the organ and localized is it is contained in one organ but in different layers
87
what are tumor markers used for?
monitor to see if body is responding to treatment
88
what are the different treatments for cancer?
surgery radiation chemotherapy
89
how long should pt wait for chemo if pt has had surgery? viseversa
4 weeks
90
what does chemotherapy do?
delay healing
91
most frequent treatment method
surgery
92
what can surgery be used in conjunction with chemo or radiation for?
prevent diagnose stage treat
93
what are the types of surgery?
diagnostic primary prophylactic palliative reconstructive
94
shave off with blade send off to lab no sutures needed
shave biopsy
95
cylindrical blade goes deep into the different sub q layered tissue closed with sutures
punch biopsy
96
affected tumor is large to remove so they do an incision close with sutures, portion of the tumor is removed
incisional biopsy
97
30G needle aspirates tissue affected area, usually painless
fine needle
98
12G needle aspirates more tissue; very painful
core needle biopsy
99
remove as much of tumor as possible
debulking
100
can be disfiguring and alter function
radical excision
101
extensive surgery to site at which previous therapies have failed
salvage surgery
102
removal of non-vital tissue/organs that may develop cancer
prophylactic surgery
103
what are the considerations of prophylactic surgery?
-family hx and genetic predisposition -presence or absence of symptoms -risks vs benefirs -ability to detect cancers early -patients acceptance of post-op outcome
104
-no pain -not intended to cure -goal is high quality of life -to alleviate disease without curing
palliative surgery
105
trying to repair injury or loss of function from curative or radical surgeries -plastic surgery -may take several procedures
reconstructive surgery
106
what should nurse do with surgical patient?
-incision care -prevent infection -manage pain -educate on drains, infections, dietary intake to promote healing
107
what should surgical patients diet contain to promote healing?
protein and vitamin c
108
eliminate cancerous cells -affects rapidly proliferating cells
radiation and chemotherapy
109
-uses energy to kill cells or shrink cells -damage cell's DNA -damage healthy cell's along the way -treatment of choice for localized cancer
radiation therapy
110
how long is radiation given for?
over weeks
111
why is radiation given over weeks?
allows periphery of tumor to re-oxygenate and become more susceptible to radiation
112
dependent on presence of oxygen
radiosensitivity of the tumor
113
point at which normal tissues are irreparably damaged
normal tissue tolerance
114
total prescribed dose usually divided into several smaller doses Treatments are usually given daily, 5 days per week for an average of 25 to 30 treatments
volume of tissue to be irradiated
115
what are the benefits of radiation therpay?
-used before surgery to shrink the tumor -intra-operative radiation -given before, during or after chemo -palliative
116
-localized to area of treatment -may be higher if in conjunction with chemo
radiation toxicity
117
what is the generalized effects of radiation toxicity
fatigue anemia N&V thrombocytopenia
118
what is another name for external radiation?
teletherapy
119
what is another word for internal radiation?
brachytherapy
120
what is a good thing about brachytherapy?
it bypasses a lot of healthy tissue and saves it
121
-body usually does not give off radiation by pregnant women and small children should avoid exposure to patient
sealed implants
122
-body will give off radiation -body secretions may be contaminated -isolation
unsealed implants
122
what are some patient teachings for temporary brachytherapy?
-avoid close contact with others until treatment is completed -no contact with pregnant women -bed rest to prevent dislodging radioactive souce -maintain balanced diet, consider small frequent meals -maintain fluid intake to ensure adequate hydration 2-3 liters/day
122
what are the side effects of brachytherapy?
-fatigue -anorexia -immunosuppression
123
what are the side effects of radiation?
-fatigue -skin changes -alopecia -immunosuppression -radiation pneumonia -ulceration of oral membranes -GI: N/V/D
124
what are some patient education for radiation therapy?
-wash treated area only with tepid water and soft wash cloth -no application of heat or cold packs -use electric razor ONLY -do not use any products to the sites during treatment -do not remove treatment makings on skin -avoid wearing tight-fitting, startched, or stiff clothing over treatment area
125
patient education for radiation
do not use: adhesive tape; use paper tape =apply outside of treatment area protect: protect skin from sun exposure get: get proper diet, fluid intake for health and repair normal tissue EAT 5-6 small meals a day fat/fiber/lactose BRAT for diarrhea protect: if hair loss occurs, protect head
126
use of anti cancer drugs to eliminate cancer cells affects the entire body death may occur due to side effects
chemotherapy
127
what is the goal of chemotherapy?
kill cancerous cell while preserving other, more health cells
128
daily, weekly, monthly
administered in cycles
129
pill, injection, IV, topical, directly into body cavity
forms of administration
130
body surface area
dosage carefully calculated
131
who long can chemotherapy be excreted into the body?
up to 48 hours after treatment
132
what lab values are you monitoring closely before administering chemotherapy?
WBC RBC H&H
133
can any nurse give chemotherapy?
no, only chemo certified RN
134
before administering the chemotherapy drug what should you do first?
check the port for blood return
135
what can happen if you administer the chemotherapy without checking the blood return of the port?
extravasation
136
what should be taught to a patient receiving chemotherapy?
- hand washing -48-72 hours after chemo pt should flush toilet twice -rinse toilet with bleach once a day -caregiver should wear gloves if in contact with bodily fluids/contaminated laundry -avoid sexual activity/use 2 forms of birth control
137
what are the PPE when administering chemotherapy to a patient?
gowns and gloves
138
what are the routes of exposure of chemotherapy?
inhalation absorption ingestion
139
what are the side effects of chemotherapy?
N/V alopecia stomatitis pain enteritis diarrhea anemia fatigue myelosuppression pancytopenia neutropenia thromobocytopenia granulocytopenia
140
what is stomatitis?
ulcers in the mouth
141
N/V that occurs within 24 hours of chemo
acute
142
N/V that occurs within 2-5 days of chemo
delayed
143
N/V that occurs before chemo
anticipatory
144
premedicate pt 15-30 min before treatment -keep medicating around the clock
ondansetron
145
extreme muscle wasting loss of all muscle and fat unexplained rapid weight loss
anoerxia cachexia syndrome
146
decreased ability to fight for infection
immunosuppression
147
risk for infection increases when decreased?
WBC Neutrophils
148
risk for anemia increases when decreased?
RBC H&H
149
risk for bleeding increases when decreased
platelets
150
what happens when bone marrow becomes suppressed?
anemia infection blood loss
151
what is NADIR used for?
lowest point of blood cells occurs at different times WBC and platelets day 7-14 RBC's may take several weeks immune system compromised treatment designed around Nadir
152
Absolute Neutrophil Count >1500
no increased risk for infection
153
Absolute Neutrophil Count >10
extremely high risk
154
what are signs and symptoms of neutropenia?
-fever of 100.5 or higher -fatigue, body aches -chills, sweating -hypotension -tachycardia
154
what are symptoms of sepsis?
tachycardia low bp high respirations
155
what is neutropenia?
-abnormally low ANC -no symptoms until onset of infection
156
what are some neutropenic precautions?
-wash hands frequently -low bacteria diet -no fresh flowers, plants, pets -avoid large crowds -no visitors with infections -no immunization
157
what is thrombocytepenia
decrease platelets that promote coagulation
158
what is the reference value of thrombocytes?
150,000-400,000
159
what is the critical value of thromocytopenia?
<50,000 or >1 million
160
where are thrombocytes produced?
in the bone marrow 7-9 days
161
what are some patient education on thrombocytopenia?
-monitor stools/urine for bleeding -use electric razor only -apply ice to affected area if trauma occurs -avoid dental work or other invasive proceudures -avoid aspirin and aspirn-containing products -soft toothbrush and no flossing -no aspirin
162
what are some nursing management for thrombocytopenia?
-monitor platelet count -monitor stools and urine for occult blood -assess skin for ecchymosis, petechiae, and trauma at least every shift -educate client about bleeding safety precautions -avoid IM injections and limit venipunctures
163
what to teach patient about pain measures?
distractions imagery relaxation touch therapy
164
what are some nursing intervention for patients with chemo brain?
-use calendar or day-planner -write down everything -exercise the brain with crossword puzzles or jigsaw puzzles -get physical exercise as tolerated -ask for support
165
what is ascites
patho accumulation of fluid within the abd cavity
166
what are some nursing mangement of ascites?
-low salt diet -diuretic therapy -paracentits -may place pleurx to enable patient to drain at home
167
what are the risk factors of breast cancer?
-gender -increase age 40+ -early menarche/late menopause -family hx -high fat diet -obesity
168
what are symptoms of breast CA
-painless breast mass -painful breast mass -nipple discharge -local edema -nipple retraction -nipple crusting
169
what are primary preventions for breast CA
-wellness -smoking cessation -daily exercise -health diet -low saturated fat -high in fiber
170
what are secondary preventions og breast CA?
mammogram beginning yearly after 40yrs of age -SBE ->20 years of age -perform after menstration -same time every month
171
what are tertiary preventions of breast CA?
symptoms control rehabilitation/reconstruction
172
what is lymphedema
lifelong accumulation of fluid
173
what is the assessment of breast exam?
mass felt during BSE mammogram a non-moveable mass-typically painless usually only one breast involved skin dimpling, puckering nipple discharge peau d'orange late sign: pain, ulceration, cachexia
174
what are the diagnosis of breast CA?
ultrasound biopsy aspiration incisional excisional
175
worse case scenario not ER or PR reactive CA does not care about the hormones/hard to treat
triple negative
176
ER/PR active easiest to treat
triple positive
177
what are some treatments for breast CA?
-surgical lumpectomy simple masectomy radical or modified radical masectomy nonsurgical -chemo radiation hormonal manipulation radiation teletherapy brachytherapy; radium implants, seeds, pellets
178
what are some preventions for lymphedema?
elevation ROM, ADLs, protect
179
ABCDE METHOD A
look for asymmetrical in a mole
180
ABCDE METHOD B
assess for an irregular border
181
ABCDE METHOD C
is the color a mixture of different color or has it recently changes
182
ABCDE METHOD D
is the diameter >6mm
183
ABCDE METHOD E
has there been an evolution in the mole size, shape, color
184
develops from abnormal B cells rare 5 subtypes
hodgkins
185
what are symptoms of hodgkins
nigh sweats itchy skin itchy head wt loss fatigue
186
develops from abnormal B or T cells 60 subtypes low cure rate
non hodgkins
187
is reed-sternberg cell in hodgkins or non-hodgkin?
hodgkins
188
antibiotics s/e: nausea and headache -most effective against H.pylori -avoid alcohol -should not be taken during pregnancy -when treating h.pylori more than one antibiotic should be used
metronidazole
189
H2 blocker suppress secretion of gastric acid contraindicated for people with renal impairment
ranitidine
190
PPI -suppress secretion of gastric acid most effective s/e: diarrhea and headaches tablets cannot be crushed
pantoprazole
191
antiulcer drug -creates a protective barrier against acid -administer 1 hour before meals or at bedtime
sucralfate
192
antacids neutralizes stomach acid s/e: constipation take with a full glass of water
aluminum hydroxide
193
antiemetic prevents n/v s/e: headache diarrhea -should not be given to pt with long QT syndrome (arrythmeias)
ondansetron
194
antiemetic -decrease vomiting s/e: involuntary repetitive body movement, include grimace, sticking out tongue or lip smaking a/e: respiratory depression
promethazine
195
prokinetic increase upper GI motility and suppressess emesis s/e: long term high therpay tardive dyskinesia repetitive involuntary movemnt -moves food along
metoclopramide
196
bulk forming laxative acts fiber in the bowel, increases bulk of fecal volume therefore stimulates peristalis -work 1-3 days -full glass of water
psyllium
197
stool softner
docusate sodium
198
-stimulant laxative - increase the number of water/electrolytes within the intestinal lumen -body will become addicted -acts within 6-12hrs after taking
bisacodyl
199
antidiarrheal decrease intestinal motility
diphenoxylate (lomotil) loperamide (imodium)
200
what is the bile that is in the liver called?
bilirubin
201
what does the liver convert that will be excreted via urine?
ammonia
202
what does bile help absorb?
vitamins
203
what does the gallbladder store from the liver?
bile
204
what does the stomach have that helps with processing food into chyme?
gastric glands
205
what does the stomach have that helps it breakdown?
gastric acids
206
helps with digestion of food and regulated BS -bicarbs
pancreas
207
dehydrates whats left of the food and forms it into stool. it also absorbs water and electrolytes during this process
large intestine-colon
208
joins into the large bowel. the appendix is attached on the outside of the cecum
the small bowel
209
most of the absorption of nutrients from food takes place
small intestine
210
what are the causes of constipation?
opiods no fiber intake decrease fluids sedentary lifestyle no exercise
211
what are interventions for constipation?
increase exercise increase fluid intake increase fiber intake
212
what medications can you take for constipation?
stool softner miralax psyllium metoclopramide
213
what is IBS?
constipation or diarrhea
214
what is a intervention for IBS?
food diary
215
whats considered diarrhea?
3+ loose stools a day
216
what are some questions you can ask patient with diarrhea?
how long have you had diarrhea? have you traveled? where did you eat? any one at home sick?
217
what are some causes of diarrhea?
viruses bacteria c-diff
218
what are some nursing assessments for a pt with diarrhea?
modifying skin underlying history IV fluids stool cultures lab and check electrolytes
219
what are c-diff precautions?
gowns gloves must use soap and water
220
what are the risk factors for peptic ulcers?
h.pylori long term use of NSAIDS physical stress
221
what are some interventions for peptic ulcers?
NG tube/suction IV fluids NPO Pain meds Labs H&H VS
222
what medication should pt take if they have peptic ulcers?
PPI (pantoprazole) H2 Blocker (rantidine) anticulcer(sulfacate)
223
what is a EDG
endoscopy that looks at the esophageal gastric duodenal mucosa
224
what are complications of peptic ulcers?
hemmorage perforation gastric outlet obstruction
225
can turn into shock check H&H hypotension tachycardia respiratory distress vomit blood
hemmorage
226
septic shock increase WBC
perforation
227
swelling, food gets stuck
gastric outlet obstruction
228
burning sensation between meals/nights, pain stops if you eat or take antacids, pain comes and goes, bloating
peptic ulcer disease
229
what can cause dysphagia?
parkinsons brain injury alzheimers stroke
230
what are some interventions for people with dysphagia?
thick food slow sit up speech therapist- swallow study
231
acid that travels back to the esophagus
GERD
232
halitosis, belch, a feeling that food is stuck. Peristalis of 2/3 of the esophagus is absent due to neuro response
achalasis
233
what are some symptoms of alchalais?
felling stuck nasty breath
234
what is the treatment for alchalasis?
injecting botox calcium channel blocker
235
chronic/acute inflammation of gallbladder
cholecystitis
236
what are the risk factor for cholecystitis?
more common in women 40+ postmenopausal sedentary lifestyle obesity family tendency
237
visualize common bile duct
ERCP
238
what are the symptoms of cholecystitis?
pain associated after eating high fat meal, fever, jaundice, pain can be referred to shoulder/scapula and N/V
239
what are nursing interventions for cholecystitis?
NG tube IV fluid NPO stop high fatty meals
240
what some lab/diagnostics for cholecystitis?
ultrasonography liver function test serum bilirubin WBC HIDA scan
241
what are the risk factors for acute pancreatitis?
gallbladder disease chronic alcohol abuse
242
what are the symptoms of acute pancreatitis?
sudden onset pain, fever, n/v jaundince hypotension
243
what are the labs for acute pancreatitis?
serum amylase (very high) lipase high WBC urinary amylase
244
what are intervention/teaching for acute pancreatits?
pt needs to recover/rest from alcohol pt finds support TPN IV FLUIDS NPO
245
why do pts get pancreatitis?
the enzymes get stuck and start eating the pancreas
246
what causes chronic pancreatits?
chronic alcohol abuse
247
what are the meds for acute pancreatits?
pain meds ondansetron
248
what is the number one cause for cirrhosis?
fatty liver
249
what causes hep A?
oral fecal contamination
250
what interventions for Hep A?
good handwashing
251
what causes drug induced hepatits?
acetaminophen
252
what causes hep b?
mom to baby needle sticks body fluids vaginal secretions
253
what disease stays in the liver dormant for years until you feel sick and get labs and you get the results?
hep c
254
how do you get hep c?
blood transfusions sexual activity needles
255
what are the labs for liver disease?
ast & alt pt ammonia levels bilirubin
256
indicator of liver damage
ast & alt
257
hepatic encephalopathy
ammonia levels
258
accumulation of serous fluid in peritoneal or abd cavity
ascietes
259
what are the nursing assessment for ascietes
measure the girth
260
their will always be damage to your liver
hep c
261
what are the causes of inflammatory bowel disease?
crohn's disease ulcerative colitis
262
does crohn's disease have a cure?
no
263
what are the symptoms of crohns disease?
diarrhea cramping pain malabsorption wt loss fever fatigue
264
disease can occur between healthy bowel and disease bowel, this is called skip lesions
crohn's disease
265
starts in the rectum and moves up the colon
ulcerative colitis
266
what are the signs and symptoms of ulcerative colitis?
blood diarrhea 10+ a day cramping pain wt loss fever fatigue anemia anorexia
267
what labs will you get for ulcerative colitis?
h&h electrolytes
268
what is the cure for ulcerative colitis?
total protocolectomy
269
is crohns and ulcerative colitis autoimmune
yes
270
what are the risk factor of diverticulitis?
constipation inactivity lack of dietary fiber obesity smoking
271
what are the signs and symptoms of diverticulitis?
vomiting increase pain increase temp
272
what meds should you take with diverticulitis?
ondansetron
273
what are the interventions of diverticulitis?
IV fluid ng tube i&o NPO
274
infection/inflammation of diverticulum
diverticulitis
275
things to know about diverticulitis?
pouch is out sigmoid colon
276
what is the main cause of intestinal obstruction in the large bowel?
colorectal cancer
277
what is the main cause of intestinal obstruction in the small bowel?
surgical adhesions crohns disease
278
what are the signs and symptoms of intestinal obstruction?
vomiting cramping pain
279
what are the interventions of intestinal obstruction
iv fluids labs i&o ng tube/suction npo
280
pain, bleeding, unusual difficulty swallowing rapidly elevated temperature
perforation
281
what is the route during a colonoscopy
anus rectum sigmoid transverse ascending colon
282
what are the nursing interventions for a colonoscopy
bowel prep left side w legs to chest
283